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HomeMy WebLinkAboutSelect Electric CIP Agreement HSIP Cycle 9 upd DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 Agreement No. AGREEMENT FOR PUBLIC WORKS CONSTRUCTION Select Electric, Inc. Forthe HSIP Cycle 9 Traffic Signal Improvements CIP PROJECT NO. Z10066 This Agreement for Public Works Construction ("Agreement") is made and entered into as of May 23, 2023 by and between the City of Lake Elsinore, a municipal corporation ("City") and Select Electric, Inc., a Corporation ("Contractor"). The City and Contractor, in consideration of the mutual promises and covenants set forth herein, agree as follows: 1. The Project and Project Documents. Contractor agrees to construct the following public improvements ("work") identified as: HSIP Cycle 9 Traffic Signal Improvements (the"Project") The City-approved plans for the construction of the Project, which are incorporated herein by reference and prepared by KOA Corporation, are identified as: Traffic Signal Improvements HSIP Cycle 9 The Project Documents include this Agreement and all of the following: (1) the Notice Inviting Bids, Instructions to Bidders, Bid Documents including Bidder's Proposal as submitted by the Contractor, Contract Documents, General Specifications, Special Provisions, and all attachments and appendices; (2) everything referenced in such documents, such as specifications, details, standard plans or drawings and appendices, including all applicable State and Federal requirements; (3) all required bonds, insurance certificates, permits, notices, and affidavits; and (4) any and all addenda or supplemental agreements clarifying, amending or extending the work contemplated as may be required to insure completion in an acceptable manner. All of the provisions of the above-listed documents are made a part of this Agreement as though fully set forth herein. 2. Compensation. a. For and in consideration of the payments and agreements to be made and performed by City, Contractor agrees to construct the Project, including furnishing all materials and performing all work required for the Project, and to fulfill all other obligations as set forth in the Bidder's Proposal, such contract price being One Million Five Hundred Ninety- Five Thousand Two Hundred Ninety-Five dollars ($1,595,295.00). 1 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 b. City hereby promises and agrees to employ, and does hereby employ, Contractor to provide the materials, do the work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the prices set forth, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Project Documents. C. Contractor agrees to receive and accept the prices set forth in the Bidder's Proposal as full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Such compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of work during its progress or prior to its acceptance including those for well and faithfully completing the work and the whole thereof in the manner and time specified in the Project Documents; and also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the work, suspension or discontinuance of the work, and all other unknowns or risks of any description connected with the work. 3. Completion of Work. a. Contractor shall perform and complete all work within Ninety (90) working days from the date of commencement specified in the Notice to Proceed, and shall provide, furnish and pay for all the labor, materials, necessary tools, expendable equipment, and all taxes, utility and transportation services required for construction of the Project. b. All work shall be performed and completed in a good workmanlike manner in strict accordance with the drawings, specifications and all provisions of this Agreement as hereinabove defined and in accordance with applicable laws, codes, regulations, ordinances and any other legal requirements governing the Project. C. Contractor shall not be excused with respect to the failure to so comply by any act or omission of the City, the City Engineer, a City inspector, or a representative of any of them, unless such act or omission actually prevents the Contractor from fully complying with the requirements of the Project Documents, and unless the Contractor protests at the time of such alleged prevention that the act or omission is preventing the Contractor from fully complying with the Project Documents. Such protest shall not be effective unless reduced to writing and filed with the City within three (3) working days of the date of occurrence of the act or omission preventing the Contractor from fully complying with the Project Documents. d. City and Contractor recognize that time is of the essence in the performance of this Agreement and further agree that if the work called for under the Agreement is not completed within the time hereinabove specified, damages will be sustained by the City and that, it is and will be impracticable or extremely difficult to ascertain and determine the actual amount of damages the City will sustain in the event of, and by reason of, such delay. It is, therefore, agreed that such damages shall be presumed to be in the amount of Five Hundred dollars ($500.00) per calendar day, and that the Contractor will pay to the City, or City may retain from amounts otherwise payable to Contractor, such amount for each calendar day by which the Contractor fails to complete the work, including corrective items of work, under this Agreement within the time hereinabove specified and as adjusted by any changes to the work. 2 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 4. Changes to Work. City and Contractor agree that the City may make changes to the work, or suspend the work, and no matter how many changes, such changes or suspensions are within the contemplation of the Contractor and City and will not be a basis for a compensable delay claim against the City nor be the basis for a liquidated damage claim against the Contractor. Any change to the work shall be by way of a written instrument ("change order") signed by the City and the Contractor, stating their agreement to the following: a. The scope of the change in the work; b. The amount of the adjustment to the contract price; and c. The extent of the adjustment to the Schedule of Performance. The City Engineer is authorized to sign any change order provided that sufficient contingency funds are available in the City's approved budget for the Project. All change in the work authorized by the change order shall be performed under the applicable conditions of the Project Documents. City and Contractor shall negotiate in good faith and as expeditiously as possible the appropriate adjustments for such changes. 5. Bonds. Contractor shall provide, before commencing work, a Faithful Performance Bond and a Labor and Material Bond, each for one-hundred percent (100%) of the contract price in the form that complies with the Project Documents and is satisfactory to the City Attorney. 6. Non-Assignability. Neither this Agreement nor any rights, title, interest, duties or obligations under this Agreement may be assigned, transferred, conveyed or otherwise disposed of by Contractor without the prior written consent of City. 7. Licenses. Contractor represents and warrants to City that it holds the contractor's license or licenses set forth in the Project Documents, is registered with the Department of Industrial Relations pursuant to Labor Code Section 1725.5, and holds such other licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Contractor. Contractor represents and warrants to City that Contractor shall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Contractor to practice its profession. Contractor shall maintain a City of Lake Elsinore business license. 8. Indemnity. Contractor shall indemnify, defend, and hold harmless the City and its officials, officers, employees, agents, the County and Board Supervisors, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the quality or character of their work. The foregoing obligation of Contractor shall not apply when (1) the injury, loss of life, damage to property, or violation of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contractor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to 3 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 property, or violation of law. It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply. By execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a material element of consideration. 9. Insurance Requirements. a. Insurance. Contractor, at Contractor's own cost and expense, shall procure and maintain, for the duration of the Agreement, unless modified by the City's Risk Manager, the following insurance policies. i. Workers' Compensation Coverage. Contractor shall maintain Workers' Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California. In addition, Contractor shall require each subcontractor to similarly maintain Workers' Compensation Insurance and Employer's Liability Insurance in accordance with the laws of the State of California for all of the subcontractor's employees. Any notice of cancellation or non-renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. In the event that Contractor is exempt from Worker's Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation Insurance in a form approved by the City Attorney. ii. Commercial General Liability Coverage. Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii. Automobile Liability Coverage. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 ("any auto"). No endorsement may be attached limiting the coverage. 4 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 iv. Builder's Risk Coverage. Prior to the commencement of any construction of the Project, Design-Builder shall obtain (or cause to be obtained) and keep in force during the term of any construction, builder's risk insurance insuring for all risks of physical loss of or damage (excluding the perils of earthquake and flood). V. Professional Liability Coverage Contractor shall maintain professional errors and omissions liability insurance appropriate for Contractor's profession for protection against claims alleging negligent acts, errors or omissions which may arise from Contractor's services under this Agreement, whether such services are provided by the Contractor or by its employees, subcontractors, or sub consultants. The amount of this insurance shall not be less than one million dollars ($1,000,000) on a claims-made annual aggregate basis, or a combined single limit per occurrence basis. b. Endorsements. Each general commercial liability and automobile liability insurance policy shall be with insurers possessing a Best's rating of no less than A:VII and shall be endorsed with the following specific language: i. The City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insured with respect to liability arising out of work performed by or on behalf of the Contractor, including materials, parts or equipment furnished in connection with such work or operations. ii. This policy shall be considered primary insurance as respects the City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self-insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company. iv. The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. V. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elected or appointed officers, officials, employees, agents or volunteers. vi. The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days written notice has been received by the City. C. Deductibles and Self-Insured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City. At the City's option, Contractor shall demonstrate financial capability for payment of such deductibles or self-insured retentions. d. Certificates of Insurance. Contractor shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of 5 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. 10. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. If to City: City of Lake Elsinore Attn: City Manager 130 South Main Street Lake Elsinore, CA 92530 With a copy to: City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, CA 92530 If to Contractor: Select Electric, Inc. Attn: Allen McLane 2790 Business Park Drive Vista, CA 92081 11. Entire Agreement. This Agreement constitutes the complete and exclusive statement of agreement between the City and Contractor. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement. 12. Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 13. Assignment and Subcontracting. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties for obligations of the Contractor under this Agreement will be permitted only with the express consent of the City. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 14. Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement. 15. Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 16. Controlling Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 6 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 17. Litigation Expenses and Attorneys' Fees. If either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys'fees. 18. Mediation. The parties agree to make a good faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. If the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMS or its successor in interest. JAMS shall provide the parties with the names of five qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. If the dispute remains unresolved after mediation, either party may commence litigation. 19. Authority to Enter Agreement and Administration. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party. The City Manager is authorized to enter into an amendment or otherwise take action on behalf of the City to make the following modifications to the Agreement: (a) a name change; (b) grant extensions of time; (c) non-monetary changes in the scope of services; and/or (d) suspend or terminate the Agreement. The City Engineer shall act as the Project administrator on behalf of the City. 20. Prohibited Interests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Agreement. Further, Contractor warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 21. Equal Opportunity Employment. Contractor represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. 22. Prevailing Wages. a. Contractor and all subcontractors shall adhere to the general prevailing rate of per diem wages as determined and as published by the State Director of the Department of Industrial Relations pursuant to Labor Code Sections 1770, 1773, and 1773.2. Copies of these rates and the latest revisions thereto are on file in the office of the City Clerk of the City of Lake Elsinore and are available for review upon request. 7 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 b. Contractor's attention is directed to the provisions of Labor Code Sections 1774, 1775, 1776, 1777.5 and 1777.6. Contractor shall comply with the provisions of these Sections. The statutory provisions for penalties for failure to comply with the State's wage and the hours laws will be enforced. C. Labor Code Sections 1774 and 1775 require the Contractor and all subcontractors to pay not less than the prevailing wage rates to all workmen employed in the execution of the contract and specify forfeitures and penalties for failure to do so. The minimum wages to be paid are those determined by the State Director of the Department of Industrial Relations. Labor Code Section 1776 requires the Contractor and all subcontractors to keep accurate payroll records, specifies the contents thereof, their inspection and duplication procedures and certain notices required of the Contractor pertaining to their location. The statutory penalties for failure to pay prevailing wages will be enforced. If the Project has been awarded to Contractor on or after April 1, 2015, Contractor and its subcontractors must furnish electronic certified payroll records to the Labor Commissioner. Beginning January 1, 2016, Contractor and its subcontractors must furnish electronic certified payroll records to the Labor Commissioner without regard to when the Project was awarded to Contractor. d. Labor Code Section 1777.5 requires Contractor or subcontractor employing tradesmen in any apprenticeable occupation to apply to the Joint Apprenticeship Committee nearest the site of the public works project, which administers the apprenticeship program in that trade for a certificate of approval. The certificate will also fix the ratio of apprentices to journeymen to be used in the performance of the Agreement. The Contractor is required to make contributions to funds established for the administration of apprenticeship programs if the Contractor employs registered apprentices or journeymen in any apprenticeable trade and if other contractors on the public works site are making such contributions. Information relative to apprenticeship standards, contributions, wage schedules and other requirements may be obtained from the State Director of Industrial Relations or from the Division of Apprenticeship Standards. Labor Code Section 1777.6 provides that it shall be unlawful to refuse to accept otherwise qualified employees as registered apprentices solely on the grounds of race, religious creed, color, national origin, ancestry, sex, or age. e. Eight hours labor constitutes a legal day's work, as set forth in Labor Code Section 1810. 23. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. In approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. [Signatures on next page] 8 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the date first written above. "CITY" "CONTRACTOR" CITY OF LAKE ELSINORE, a municipal Select Electric Inc., a Corporation corporation DocuSigned by: t eav im Sbin DocuSigned by: J S p 6/28/2023 � 1:41 PM P T Q 6/28/2023 1:35 PM PDT City anager By: Allen McLane Its: President ATTEST: DocuSigned by: 6/28/2023 4:28 PM PDT City er APPROVED AS TO FORM: DocuSigned by: 6/27/2023 5:38 AM PDT City Attorney (DocuSigned by: SLutv.hvu ! MU" 6/7/2023 1 5:12 PM PDT Assistant City Manager 9 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 EXHIBITA CONTRACTOR'S PROPOSAL [ATTACHED] DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 BIDDER'S PROPOSAL HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO.Z10066 FEDERAL PROJECT NO. 5074(020) Company: Select Electric, Inc. Honorable Mayor, Members of the Council: In accordance with the Notice Inviting Bids pertaining to the receiving of sealed proposals by the City Clerk of the City of Lake Elsinore for the above titled improvement, the undersigned hereby proposes to furnish all Work to be performed in accordance with the Specifications, Standard Drawings, and the Contract Documents, for the unit price or lump sum set forth in the following schedule: Time of Completion: Ninety (90) Working Days from Issuance of Notice to Proceed (NTP) by City to Contractor. BID SCHEDULE ITEM ESTIMATED UNIT NO. DESCRIPTION OF ITEMS UNIT QUANTITY PRICE AMOUNT GENERAL OVERHEAD&MOBILIZATION/DEMOBILIZATION 1 Mobilization. LS 1 2 Traffic Control. LS 1 3 Signing and Striping Improvements. LS 1 3 40. 53 MIDI 4 Demo/Unclassified Excavation CY 61 5 Remove Curb and Gutter LF 435 r 6 Remove Asphalt Berm .LF 43 7 Remove Sidewalk,Curb Ramps,and SF 2493 Driveways 8 Asphalt Grinding CY 2203 9 Install 8°Curb and Gutter LF 452 CJ% QA U. 10 Install 6"Curb and Gutter LF 253 �Ja. 11 Install Curb Only LF 23 12 Install Sidewalk SF 3723 00 a 13 AC Pavement(slot patch&base course) TON 62 14 Install Concrete Pavement SF 852 I 91319. 15 Install Curb Ramp EA 13 5 16 Top Soil and Grading CY 4 'IS 17 Install Detectable Warning Surface on EA 9 ��� �G — Existing Curb Ram -J� C-8 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF9lB356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 18 Grind Existing Lip EA 5 a 19 2"Overlay TON 10 20 Grind PCC Pavement SF 675 21 Adjust Utility Valve Cover to Grade EA 3 rJ r 22 Adjust Utility Box Cover to Grade EA 20 Q a0y�OCR. Traffic Signal Modifications 23 Traffic Signal Modification at Lake Street& LS 1 I" Temescal Canyon 24 Traffic Signal Modification at Lake Street& LS 1 Mountain Street 25 Traffic Signal Modification at Grand Avenue& LS 1 BroadwayStreet 0 CQ) 101.11 1q 5. 26 Traffic Signal Modification at Grand Avenue& l LS 1 Lincoln Street I_ a 27 Traffic Signal Modification at Lakeshore Drive LS 1 &Machado Street 16- 49 a29' 28 Traffic Signal Modification at Lakeshore Drive LS 1 &Visca a Street �5 3 S 3fJ4• 29 Traffic Signal Modification at Lakeshore Drive LS &Chaney Street 30 Traffic Signal Modification at Mission Trail& LS 1 4 Malaga Road 31 Traffic Signal Modification at Central Avenue LS 1 &Dexter Avenue 53.3 1�3 311. 32 Traffic Signal Modification at Canyon Hills LS 1 Road&Cottonwood Canyon Road _ � ai% 7 ads - Total Bid Price o�q5•®p TOTAL BID PRICE: TOTAL BID PRICE BASED ON BID SCHEDULE TOTAL OF UNIT PRICES FOR HSIP CYCLE 9 TkAFFIC SIGNAL IMPROVEMENTS $ 5. aq5 01) Total Bid Price in Numbers 1FA\)1e\-h6Uaard.Two F1u,r,e�rr Total Bid Price in W n Form t�►ne-i�•j #eve Un1\axs cy'd 2eko CAS . In case of discrepancy between the written price and the numerical price, the written price shall prevail. Note: Estimated quantities are for the purpose of Bid comparison only; payments will be made on the basis of actual measurement of work completed, except for lump sum (LS) and final pay (F) quantities. (S) denotes a specialty item. The Bid Price shall include, but not be limited to, sales tax and all other applicable taxes and fees.All work described on the plans and in the specifications and other incidentals necessary to complete the project shall be paid under items above. No additional payments will be allowed. *BID MAY BE REJECTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AND WORDS. C-9 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 BIDDER'S SIGNATURE HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) The undersigned agrees to enter into and execute a contract, with necessary bonds, at the unit prices set forth herein and in case of default in executing such contract, with necessary bonds, the check or bond accompanying this bid and the money payable thereon shall be forfeited thereby to and remain the property of the City of Lake Elsinore. The above unit prices include all work appurtenant to the various items as outlined in the Specifications and all work or expense required for the satisfactory completion of said items. In case of discrepancies between unit prices and totals, the unit prices shall govern. The undersigned declares that it has carefully examined the Plans, Specifications, and Contract Documents, and has investigated the site of the work and is familiar with the conditions thereon. Select Electric, Inc. ntractor Date: 3/31/2023 By Contractor's State License No.: 297034 Class: & B, C-7 C-10 Department of Industrial Relations Registration No: 1000001036 Registration Date: 08/25/2014 Expiration Date: 06/30/2023 Address: 2790 Business Park Dr. Vista CA. 92081 Phone: 562-584-1766 FAX: 562-658-2201 C-10 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 ACKNOWLEDGMENT OF ADDENDA RECEIVED HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) The Bidder shall acknowledge the receipt of addenda by placing an 'W' by each addendum received. Addendum No. 1 Addendum No. 2 Addendum No. 3 Addendum No. 4 If an addendum or addenda have been issued by the City and not noted above as being received by the Bidder, the Bid Proposal may be rejected. 3/30/2023 Date C-11 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 NON-COLLUSION AFFIDAVIT HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO.Z10066 FEDERAL PROJECT NO. 5074(020) STATE OF CALIFORNIA } SS COUNTY OF ) (NAME)_ Allen McLane affiant being first duly sworn, deposes and says: That he or she is President of (sole owner, partner or other proper title) Select Electric. Inc. _ ___ the party making the foregoing Bid, that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the Bid is genuine and not collusive or sham; that the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham Bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham Bid, or that anyone shall refrain from bidding; that the Bidder has not in any manner, directly or indirectly sought by agreement, communication, or conference with anyone to fix the bid price of the Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other Bidder, or to secure any advantage against the public body awarding the Contract of anyone interested in the proposed Contract; that all statements contained in the Bid are true; and, further, that the Bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company associations, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham Bid. (Public Contract Code Section 7106) Address: 2790 Business Park Dr. Vista, CA. 92081 Telephone No.: 562-584-1766 Print Name: Allen McLan _ Signature: ii�� - Title: Pr i n Date: 3/30/23 _ SIGNING INSTRUCTIONS TO THE CONTRACTOR Non-Collusion Affidavit must be accompanied by notary certificates for signature. Note the description of the document on the notary certificate. Attach notary► certificate immediately following this_9aq. If the Bidder fails to properly sign or omits the required signature, the bid will be considered non-responsive and will be rejected. C-12 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy, or validity of that document. State of California ) County of Los Angeles ) On 4-5-23 _ before me, Kristen Czucjryn, Notary Public , Date Here Insert Name and Title of the Officer personally appeared Allen McLane Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. „ orT KRISTENRENEECZUPRYN� WITNESS my h nd and official sera., Notary Public.California I '- Orange County Commission#2360170 My Comm.Expires Jun 7,2025 Signature ignature o otary r U �c Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: _Non-Collusion Affidavit Document Date: 3-30-23 Number of Pages: 1 Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(s) Signer's Name: Allen McLane Signer's Name: [l Corporate Officer — Title(s): President EX Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: _ Signer Is Representing: Select Electric, Inc. Signer Is Representing: 02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 BOND NO. N/A BIDDER'S BOND HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) KNOW ALL MEN OR WOMEN BY THESE PRESENTS: That we Select Electric, Inc. as PRINCIPAL, hereinafter referred to as "Contractor", and Fidelity and Deposit Company of Maryland a duly authorized corporate as "Surety," are held and firmly bound unto the City of Lake Elsinore in the penal sum of TEN PERCENT (10%) OF THE TOTAL AMOUNT OF THE BID of the Contractor above named, submitted by said Contractor to the City of Lake Elsinore for the work for said project entitled above, for the payment of which sum in lawful money of the United States, well and truly to be made, to the City of Lake Elsinore to which said bid was submitted, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. In no case shall the liability of the surety hereunder exceed the amount of Ten Percent 10%) of the Total Amount Bid THE CONDITION OF THIS OBLIGATION IS SUCH: That whereas the Contractor has submitted the above-mentioned Bid to the City of Lake Elsinore as aforesaid for the work for said project entitled above. NOW, THEREFORE, if the aforesaid Contractor is awarded the Contract and, within the time and manner required under the Contract documents, after the prescribed forms are presented to him or her for signature, enters into a written Agreement in the prescribed form and in accordance with the Contract documents, and files two bonds with the City of Lake Elsinore, one to guarantee faithful performance and the other to guarantee payment for labor and materials, in accordance with said Contract documents, and as required by law, and files the required insurance certificate(s) in accordance with said Contract documents, then this obligation shall be null and void; otherwise, it shall be and remain in full force and effect until execution of the Agreement or forfeiture pursuant to the Provisions of Sections 20172 and 20174 of the Public Contract Code. In the event suit is brought upon this bond by the City and judgment is recovered, the Surety shall pay all costs incurred by the City in such suit, including a reasonable attorney fee to be fixed by the court. (SIGNATURE PAGE FOLLOWS) C-13 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE C►P Project No. Z10066 BIDDER'S BOND SIGNATURE PAGE HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) IN WITNESS WHEREOF, we have hereunto set our hands and seals on this 30thday of March 2023 BIDDER: CORPORATE SURETY: Fidelity and Deposit Contractor Name: Select Electric, Inc. Company Name: Company of Maryland Address: 2790 Business Park Drive Address: 1299 Zurich Wav, 5th Floor Vista. CA 92081 Schaumburg, IL 60196-1056 Telephone No.: (5621 807-1860 Telephone No.: �(213) 270-0715 Print Name: �An Print Name: Heather Saltarelli Title: 1 Title: Attorney-in-Fact Signatur _ Signature: W &U-WiJ, Date: "5"a3 Date: March 30, 2023 SIGNING INSTRUCTIONS TO THE CONTRACTOR Bidder's Bond must be accompanied by notary certificates for EACH signature. Note the description of the document on the notary certificate. Attach BOTH notary certificates immediately following this page. Corporate Seal may be affixed hereto. The attorney-in-fact for corporate surety must be registered, as such, in at least one county in the State of California. Attach one original Power of Attorney immediately following the notary certificates. If the Bidder fails to properly sign or omits the required signatures, the bid will be considered non-responsive and will be rejected. C-14 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of Orange ) On MAR 3 0 2023 before me, Reece Joel Diaz, Notary Public , Date Here Insert Name and Trtte of the Officer personally appeared Heather Saltarelli Name(s)of Signer(s) , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. REECE JOEL DIAZ WITNESS my Notary Public California < r=+ z i WMy Orange CountyCommission x 2294772 SI nature Comm.Expires Jun 25,2023 � :��•..-.r.�.•a �..•. .. SignaturPootaty Public Place Notary Seat Above ---- - - - OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: �YS�D4'! Document Date: 3 �o Number of Pages Signer's) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: Corporate Officer — Title(s): 1 Corporate Officer — Title(s): Partner - Limited1 General Partner -- Limited r i General Individual N,Attorney in Fact Individual S Attorney in Fact Trustee [`J,Guardian or Conservator Trustee i::"=Guardian or Conservator Other: Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association•www,NationaiNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 :r�;.•�.r�:r�:r�:r��-r�r�-c�r.�.n�n��ri=rtic`,crcl.c('.c�.�C:.c=t;car.�'x-ri=r.�('.c�,c�C.carc�C`.c�(',c�,c-rn^.c�.e=reK.ef,eat'.ere�c.e�t':�=f^,ccerc�.i A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy,or validity of that document. State of California ) County of . Los Angeles ) On 4/5/23 before me, Kristen Czupryn, Notary Public , Date Here Insert Name and Title of the Officer personally appeared Allen McLane Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. KRISTEN RENEE CZUPRYN Notary Public-California = Orange County ; Signature ' Cammissian#1360170 - My Comm.Expires Jun 7,2025 Signature f Norff e``.,"y Public Yi Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Bid Bond Document Date: 3-30-23 Number of Pages: 2 Signer(s) Other Than Named Above: . Heather Saltarelli Capacity(ies) Claimed by Signer(s) Signer's Name: Allen McLane Signer's Name: IX Corporate Officer — Title(s): President L Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑Other: __ ❑ Other: Signer Is Representing: Select Electric Inc. Signer Is Representing: 02014 National Notary Association - www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item #5907 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF9lB356DEC1 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois ("herein collectively called the "Companies"), by Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8_of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby nominate,constitute, and appoint James A. SCHALLER, Heather SALTARELLI, Mike PARIZINO, Rachelle RHEAULT, Rhonda C. ABEL, Kim LUU, Jeri APODACA.Janice R.MARTIN,Leigh MCDONOUGH.Reece Joel DIAZ of Irvine,California,its true and lawful agent and Attorney- in-Fact,to make, execute,seal and deliver,for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as Fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owlings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Matyland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V. Section 8_of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE CON1PANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARY"L AND,this 16th day of March.A.D.2022. "�t 1 ,+Illllll,ll,, }+p,41t11111,," Ysuaxy '•,, `�F,aw:dl C.,,,Q'., ^fin oP p7i•}o�: a a;�SEAL� g &itr'SEAL`� ;" ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF]MARYLAND By: Robert D. Murray Vice President J_\lcd•it%ia I By: Dawn E.Brown Secretary State of Maryland County of Baltimore On this 16th day of March, A.D. 2022, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A.Dunn,Notary Public My Commission Expires:July 9,2023 /lrlgnNN+ Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF9lB356DEC1 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE 1, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the l5th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAN.D at a meeting duly called and held on the 1 Oth day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary,or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this day of. MAR 3 0 2023 .,••"`.�{rn,.,r,h .``�•„are„_'S... ,`a•,"�.I COT��''•. F 4 SEAL! .' "SF s__ yi SEAL By: Mary Jean Pethick Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1.056 Ph: 800-626-4577 If your jurisdiction allows for electronic reporting of surety claims,please submit to: reuortsfclaims d!zuriclina.com Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 LIST OF SUBCONTRACTORS HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) The bidder is required to fill in the following blanks in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Chapter 2 of Division 5, Title 1 of the Government Code of the State of California) and should familiarize itself with Sections 2-3 of the Standard Specifications. Name Under Which Subcontractor is Licensed: Vi.C. t C License Number: �V,,paMpIlD Address of Office, Mill or Shop: LDaQ &\V V� nA% D .CN- 0120a0I Specific Description of Sub-Contract: and Bid Items ofWork: vi ; H-al Name Under Which Subcontractor is Licensed: 'w,�p xiOr ��hexv�2,r�"'C 1�1ar�r�wS�1 - License Number: "1-JU M)LD a as 3 Address of Office, Mill or Shop: Pr bQX c -1�. Specific Description of Sub-Contract: and Bid Items of Work Name Under Which Subcontractor is Licensed: License Number: _ Address of Office, Mill or Shop: _. Specific Description of Sub-Contract: and Bid Items of Work:___ Name Under Which Subcontractor is Licensed: License Number: _ Address of Office, Mill or Shop: Specific Description of Sub-Contract: and Bid Items of Work:_ Subcontractors listed in accordance with the provisions of Section 2-3 must be properly licensed under the laws of the State of California for the type of work that they are to perform. Do not list alternate subcontractors for the same work. C-15 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 REFERENCES HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) Failure to demonstrate adequate experience may result in rejection of the bid. For all public agency projects with a similar scope of work which you have worked on (or are currently working on) in the past three (3) years, provide the following required information: 1. Name (Firm/Agency): City of Downey Address: 11111 Brookshire Ave. Downey, CA. 90241 Contact Person: Amaka Udeoii Telephone No.: 562-904-7110 Title of Project: Woodruff Ave traffic Signal Fiber Optic Communication System and Upgrades Project Project Location: Downey, CA. Date of Completion: Februa 2021 Contract Amount: $833,036 00 2. Name (Firm/Agency): City of Pasadena Address: 100 North Garfield Ave. Pasadena. CA 91101 Contact Person: Sarah Tawadrous Telephone No.: 626 744-8479 Title of Project: Traffic Signal Improvements at Various Locations Contract#31,756 Project Location: Pasadena, CA. Date of Completion: December 2022 Contract Amount: $209 990.00 3. Name (Firm/Agency): CALTRANS Address: 1120 N St. Sacramento, CA. 95814 Contact Person: Kenicia Lemos Telephone No.: 626-339-1601 x122 Title of Project: 07-1170U4 Route 10 West Covina Project Location: West Covina CA. Date of Completion: September 2022 Contract Amount: 8 605 466.3 C-16 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 4. Name (Firm/Agency): City of Long Beach Address: 411 W. Ocean Blvd 5th Floor. Long BEach, CA. 90802 Contact Person: Arek Harmandayan Telephone No.: 562-570-6764 Title of Project: R-7190 Ten Signalized Intersections on Los Coyotes Diagonal Project Location: Long Beach CA. Date of Completion: In Progress Contract Amount: $1,197,500.00 5. Name (Firm/Agency): City of Norwalk Address: 12700 Norwalk Blvd. Norwalk CA. 90650 Contact Person: Raymond Velasco Telephone No.: 562-929-5723 Title of Project: Traffic Signal Improvements on Rosecrans Ave Studebaker Rd to Carmenita Rd. Project Location: Norwalk, CA. _ Date of Completion: In Progress__ Contract Amount: 1 690 225.00 6. Name (Firm/Agency): Address: Contact Person: Telephone No.: Title of Project: Project Location: Date of Completion: Contract Amount: 7. Name (Firm/Agency): Address: Contact Person: Telephone No.: Title of Project: Project Location: Date of Completion: Contract Amount: C-17 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 List any other projects (private, older than three (3)years, etc.)that may represent qualifying or similar experience: 1. Name (Firm/Agency): City of Chula Vista Address: 276 Fourth Ave. Chula Vista CA. 91910 Contact Person: Jose Gomez Telephone No.: 619-691-5021 Title of Project: Traffic Signal Modifications at Broadway/F Steet and Broadway/G St. TF402 Project Location: Chula Vista CA. Date of Completion: May 2020 Contract Amount: $572 074 00 2. Name (Firm/Agency): City of Los Angeles Address: 200 N. Spring St Los Angeles CA. 90012 Contact Person: Max Eftekhari Telephone No.: 951-741-3403 Title of Project: Wilshire Blvd BRT Communications Upgrade Phase II ATSAC Project Location: Los Angeles„ CA. Date of Completion: November 2018 Contract Amount: 2 563 285.00 _. 3. Name (Firm/Agency): City of Oceanside Address: 300 North Coast Hwy. Oceanside CA. 92054 Contact Person: Darra Woods Telephone No.: 760-435-5094 Title of Project: Rebid Mission Ave. Fiber Project Location: Oceanside-CA. Date of Completion: April 2018 Contract Amount: $752 175.00 C-18 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 CONTRACTOR INFORMATION HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) Contractor's License No.: 297034 Class: _ A: B. C-7. C-10 a. Date first obtained: 08/09/1974 Expiration 10/31/2024 b. Has License ever been suspended or revoked? No If yes, describe when and why: c. Any current claims against License or Bond? No If yes, describe claims: Principals in Company (List all-attach additional sheets if necessary): NAME TITLE LICENSE NO. (If Applicable) Allen McLane President Mario Tapanes Secretary Sam Passanisi Asst. Secretary 297034 C-19 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 VIOLATIONS OF FEDERAL STATE OR LOCAL LAWS HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) 1. Has your firm or its officers been assessed any penalties by an agency for noncompliance or violations of Federal, State or Local labor laws and/or business or licensing regulations within the past five (5)years relating to your construction projects? YES NO (circle one) Federal/State/ Local (circle one) If"YES," identify and describe, (including agency and status): Have the penalties been paid? YES/NO (circle one) 2. Does your firm or its officers have any ongoing investigations by any public agency regarding violations of the State Labor Code, California Business and Professions Code or State Licensing Laws? YES<gD (circle one) Code/Laws: Section/Article: If"yes," identify and describe, (including agency and status): C-20 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 CITY OF LAKE ELSINORE CIP Project No. Z10066 DISQUALIFICATION OR DEBARMENT HSIP CYCLE 9 TRAFFIC SIGNAL IMPROVEMENTS CIP PROJECT NO. Z10066 FEDERAL PROJECT NO. 5074(020) Has your firm, any officer of your firm, or any employee who has a proprietary interest in your firm ever been disqualified, removed, or otherwise prevented from bidding on, performing work on, or completing a federal, state or local project because of a violation of law or a safety regulation? YES NO (circle one) If yes, provide the following information (if more than once, use separate sheets): Date: Entity' Location: Reason: Provide Status and any Supplemental Statement: Has your firm been reinstated by this entity? YES/ NO (circle one) C-21 DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 76/7/2023 E(MM/DDYYY) A�" CERTIFICATE OF LIABILITY INSURANCE /Y THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Gabriel Stellar Construction Risk Partners PHONE FAX Campus View Plaza (A/C.A E-MAIL Ext: 908-566-1010 AIC No): 908-566-1020 1250 Route 28, Suite 201 ADDRESS: certs constructionrisk artners.com Branchburg, NJ 08876 INSURER(S)AFFORDING COVERAGE NAIC# www.constructionriskpartners.com INSURERA: Starr Indemnity&Liability Company 38318 INSURED INSURER B: Select Electric Inc. 2790 Business Park Drive INSURERC: Vista CA 92081 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 74748070 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP /Y LIMITS LTR INSD WVD POLICY NUMBER MM/DDYYY IY MM/DDYYY A ✓ COMMERCIAL GENERAL LIABILITY 1000025467231 3/1/2023 3/1/2024 EACH OCCURRENCE $2,000,000 GE CLAIMS-MADE 1/ OCCUR PREM DAMA ISESTO EaR ENTED occurrence $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ✓� JE� LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY 1000198716231 3/1/2023 3/1/2024 EOa.d."'SINGLE LIMIT $2000,000 ✓ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED✓ AUTOS ONLY ✓ AUTOS ONLY (pRaOar nDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 100000127016 3/1/2023 3/1/2024 ,/ STATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:HSIP Cycle 9 Traffic Signal Improvements Environmental,CIP Project No.Z10066, Federal Project No.5074(020) The City of Lake Elsinore, its elected or appointed officers,officials,employees,agents and volunteers are additional insured as required by written contract. Waiver of subrogation applies per policy provisions.Coverage is primary and non contributory as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Clty of Lake Elsinore THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 130 S. Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Lake Elsinore CA 92530 AUTHORIZED REPRESENTATIVE Peter Forenza ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 74748070 MERUGRO-01 1 23/24 GL AU UMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:44:06 AM (EST) I Page 1 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 Policy Number: 1000025467231 Named Insured: Select Electric Inc. COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations s required by written contract. As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only work, on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or damage" or "personal and advertising injury" on behalf of the additional insured(s) at the caused, in whole or in part, by: location of the covered operations has been 1. Your acts or omissions; or completed; or 2 The acts or omissions of those acting on your 2 That portion of "your work" out of which the behalf; injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization the additional insured(s) at the location(s) other than another contractor or subcontractor engaged in performing operations for a designated above. principal as a part of the same project. However: 1. The insurance afforded to such additional C. With respect to the insurance afforded to these insured only applies to the extent permitted by additional insureds, the following is added to law; and Section III— Limits Of Insurance: 2 If coverage provided to the additional insured is If coverage provided to the additional insured is required by a contract or agreement, the required by a contract or agreement, the most we insurance afforded to such additional insured will pay on behalf of the additional insured is the will not be broader than that which you are amount of insurance: required by the contract or agreement to 1. Required by the contract or agreement; or provide for such additional insured. 2 Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the "property damage" occurring after: Declaration CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 74748070 MERUGRO-01 1 23/24 GL AU UMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:44:06 AM (EST) I Page 2 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 Policy Number: 1000025467231 Named Insured: Select Electric Inc. COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract. As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II —Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 74748070 MEROGRO-01 1 23/24 GL AU OMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:99:06 AM (EST) I Page 3 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Primary and Non-Contributory Condition Policy Number: 1000025467231 Effective Date: 03/01/2023 Named Insured: Select Electric Inc. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV—CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY 8r LIABILITY COMPANY Charles H. Da Belo, President Nehemiah E. Ginsburg, Genera(Counsel OG 107(04/11) Copyright©C.V.Starr&Company and Starr Indemnity&Liability Company.All rights reserved. Page 1 of 1 Includes copyrighted material of ISO Properties,Inc.,used with its permission. 74748070 MERUGRO-01 1 23/24 GL AU UMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:44:06 AM (EST) I Page 9 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 Policy Number: 1000025467231 Named Insured: Select Electric Inc. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of paym ents we ma ke for injury o r damage arising out of yo ur ongoing operations or .'your work" done under a contract with that person or organization and in cluded in the "products- completed operations hazard". This waiver applies only to the person or organi zation shown in th e Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 74748070 MEROGRO-01 1 23/24 GL AU OMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:99:06 AM (EST) Page 5 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 POLICY NUMBER: 1000198716231 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Select Electric Inc. Endorsement Effective Date: 03/01/2023 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 74748070 MEROGRO-01 1 23/24 GL AU OMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:99:06 AM (EST) I Page 6 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 POLICY NUMBER: 1000198716231 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Select Electric Inc. Endorsement Effective Date: 03/01/2023 SCHEDULE Name Of Person(s) Or Organization(s): Where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 74748070 MEROGRO-01 1 23/24 GL AU OMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:99:06 AM (EST) Page 7 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 COMMERCIAL AUTO Starr Indemnity & Liability Company SICA-1017 (0919) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS AMENDATORY ENDORSMENT Policy Number: 1000198716231 Effective Date: 03/01/2023 Named Insured: Select Electric Inc. This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies)carefully. BUSINESS AUTO COVERAGE FORM SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, c., is amended by the addition of the following: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions of this Policy remain unchanged. SICA-1017 (0919) Copyright©Starr Indemnity&Liability Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 74748070 MERUGRO-01 1 23/24 GL AU UMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:99:06 AM (EST) I Page 8 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.0% of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description As required by written contract. Where required by contract Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 03/01/2023 Policy No.: 100000127016 Endorsement No.: Insured: Select Electric Inc. Premium: Insurance Company: Starr Indemnity&Liability Company Countersigned by: WC 04 03 06 (Ed. 04-84) Page 1 of 1 74748070 MERUGRO-01 1 23/24 GL AU UMB 5M WC L/R SCHED EQ POLL PROF I Jennifer Fine 1 6/7/2023 9:99:06 AM (EST) I Page 9 of 9 This certificate cancels and supersedes ALL previously issued certificates. DocuSign Envelope ID:76515FC2-4CC7-4B9C-B551-BF91B356DEC1 BUSINESS LICENSE CITY OF LAKE ELSINORE This business license is issued for revenue purposes only and does not grant authorization Administrative Services-Licensing to operate a business. This business license is issued without verification that the holder is 130 South Main Street, Lake Elsinore, CA 92530 subject to or exempted from licensing by the state, county, federal government, or any other governmental agency. PH (951)674-3124 Business Name: SELECT ELECTRIC INC BUSINESS LICENSE NO. 027699 Business Location: 2790 BUSINESS PARK DR Business Type: ELECTRICAL CONTRACTOR VISTA,CA 92081-7860 Owner Name(s): ALLEN MCLANE Issue Date: 6/6/2023 Expiration Date: 6/30/2024 SELECT ELECTRIC INC 10603 MIDWAY AVE CERRITOS,CA 90703-1522 Starting January 1, 2021, Assembly Bill 1607 requires the prevention of gender-based discrimination of business establishments. A full notice is available in English or other languages by going to:https://www.dca.ca.gov/publications/ TO BE POSTED IN A CONSPICUOUS PLACE THIS IS YOUR LICENSE • NOT TRANSFERABLE